Adolescent Care Transfer to Transition

“I would there were no age between ten and three and twenty, or that youth would sleep out the rest; for there is nothing in the between but getting wenches with child, wronging the ancientry, stealing, fighting”. William Shakespeare

Follow-up of adolescent patient Transfer to adult clinic (crisis situation) Long-term retention at paediatric clinic Failure to attend Discharged

Transitional care “The purposeful, planned movement of adolescents and young people with chronic physical and medical conditions from child-centred to adult-orientated health care systems.”

Key Public Health Issues Obesity Smoking Alcohol consumption Pregnancy

Top 10 topics with GP Sex Depression Stress Size/shape Relationships Drugs Diet Pregnancy General health Contraception

Health related behaviour Exercise Diet Smoking Drugs Alcohol Sexuality

Why give adolescents special consideration Numbers Workload Illness appears/worsens Mortality Little concern Great anxiety Childhood survivors

Paediatric Medicine RBHSC (Oct 04 – Sept 05) Age Inpatients Outpatients (Yrs) (Bed days) New Review DC 0-4 79% 52% 31% 14% 5-12 17% 42% 47% 46% 13+ 4% 6% 22% 39%

Cases notified to N. Ireland register 1989-2003 140 120 100 80 Cases 60 40 20 ’03 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 ’99 ’00 ’01 ’02 Year

‘I don’t believe its going to do me any harm at all ‘I don’t believe its going to do me any harm at all. You’re all just trying to scare me. I won’t believe anything you say unless I can meet someone who has had bad things happen to them because of their diabetes’ 14 year old male

Age versus HbA1c 6 8 12 14 5 10 15 HbA1c (%) Age at visit

Health care services for Children Adults Family centred Patient centred Socially orientated Disease orientated Informal and relaxed Formal and direct School/life progress Glycaemic control/ complications

Young adult survey 17 – 20 years Privacy and confidentiality Short waiting times Informality Approachable physician Continuity of care

Storm and Stress The challenge of adolescence is to achieve the desired independence and autonomy, while at the same time, maintaining close and supportive ties with the nuclear family

Transition clinics Cystic fibrosis Congenital heart disease Metabolic diseases Juvenile arthritis Diabetes and endocrine

Paediatric Conditions Requiring Adult Handover Hypothalamic/Pituitary Disease Thyroid Disease, Parathyroid Disease Polyglandular autoimmune disease, MEN Congenital adrenal hyperplasia - Addison’s Adrenarche - PCO, Cushing’s Insulin resistance Hypogonadism; Turner’s/Klinefelter’s; Intersex Sporadic endocrine tumour

Barriers to good transition Circumstances Paediatrician Patient Parent

Principles of successful transition 1. Transition policy for every paediatric clinic Preparation for transition 3. Timing – growth and puberty completed In good health

Principles of successful transition 5. Skill to cope with adult clinic An identified person in both teams 7. Management links between clinics 8. Evaluation of arrangements

Adolescent and Transitional Care Responsibility of the Paediatric Team